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General NPI Number Information
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NPI Number | 1336351600
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Entity Type | Individual
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Provider Name | PAUL ROBERT BLACK RPH
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Gender | Male
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1600 11TH ST
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City | WICHITA FALLS
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State | TX
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Zip | 76301-4300
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Country | US
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Telephone | 940-764-3211
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Fax | 940-764-3793
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Provider Business Mailing Address
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Address Line | 4827 OLYMPIC DR
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City | WICHITA FALLS
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State | TX
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Zip | 76310-2837
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Country | US
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Telephone | 940-692-3478
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 38998
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License Number State | TX
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